Transcatheter closure of a large atrial septal defect under microprobe transesophageal echocardiographic guidance

We present a case of an atrial septal defect (ASD) in a 59-year-old man with an indication for ASD closure who also had a history of chronic obstructive pulmonary disease. Because of his decreased respiratory function with multiple bullae in his lungs, the procedure was performed without general anesthesia under the guidance of fluoroscopy and two-dimensional (2D) transesophageal echocardiography (TEE) using a transesophageal echocardiographic microprobe (micro-TEE) (S8-3t; Philips Medical Systems, Andover, MA, USA). The micro-TEE probe was inserted into the esophagus smoothly and easily in the supine position without sedation. It revealed a deficient superior-anterior rim and adequate rims elsewhere, and the maximal diameter of ASD was measured to be 25 mm. Balloon sizing resulted in a stretched defect diameter of 29 mm using the stop-flow technique. A 30-mm AMPLATZER Septal Occluder (AGA Medical, Plymouth, MN, USA) was deployed. The micro-TEE demonstrated that both disks were on the appropriate sides of the interatrial septum and the device was not interfering with surround cardiac structures. Residual shunt flow was not detected with color Doppler. The device was released successfully without any complications. Recently introduced multiplane micro-TEE can provide adequate information about a large ASD with a less invasive procedure in adult patients. Micro-TEE has a potential to become a novel imaging option for interventions of the interatrial septum.     

Transcatheter atrial septal defect closure: modified balloon sizing technique to avoid overstretching the defect and oversizing the Amplatzer septal occluder.

The objective of this study was to evaluate a new technique of sizing atrial septal defects (ASDs) for transcatheter device closure. ASD closure using the Amplatzer septal occluder (ASO) device is commonly performed. Complications, including arrhythmias, pericardial effusions, and perforations, may be related to oversizing ASDs and choosing larger devices. Two methods were used to size ASDs using a compliant balloon. In some patients, the balloon was inflated until a waist was visible [(+)waist]; in others, only until no shunting was demonstrable by echocardiogram [echo; (-)waist]. The device was selected and implanted using standard procedure and echo guidance. One hundred seventeen patients underwent secundum ASD closure with an ASO device. There were 43 patients in the (-)waist group and 74 in the (+)waist group. All devices were implanted successfully. The initial echo ASD diameter was larger in the (-)waist group compared to the (+)waist group (P = 0.01). There was a smaller difference between the initial echo and balloon-sized ASD diameters in the (-)waist group (P < 0.02). ASO device size implanted (in mm greater than echo ASD diameter) was smaller in the (-)waist group (P < 0.01). There were 0/43 complications in the (-)waist group and 5/74 in the (+)waist group. The complete closure rate was the same in both groups. Sizing an ASD by inflating a compliant balloon just until shunting is eliminated, and not until a waist is visible, results in less overstretching of the ASD and selection of a smaller ASO device, achieving similar closure rates and potentially fewer complications.     

Diagnostic catheterization and balloon sizing of atrial septal defects by echocardiographic guidance without fluoroscopy

To avoid x-ray exposure prior to interventional closure of atrial septal defects (ASDs), we recently developed a technique for diagnostic catheterization and balloon sizing of the defect by echocardiographic guidance without fluoroscopy. We report on our first experiences with this technique. Fourteen patients with atrial septal perforations (mean age, 23 years; range, 1-66 years) underwent diagnostic catheterization and balloon sizing prior to possible interventional defect closure. Mean size of the defects was 16 mm (7-29 mm). Mean left-to-right shunt was Qp/Qs = 2.0 (range, 1.0-4.0). Without fluoroscopy, the procedures were performed in two children by transthoracic echocardiography (TTE) and in 12 patients by both TTE and transesophageal echocardiography (TEE). Mean procedure time was 59 minutes (range, 35-90 minutes). We conclude that oxymetry, pressure recordings, and the estimation of the balloon-stretched size of atrial septal perforations can be performed safely by echocardiographic guidance without fluoroscopy. The x-ray exposure for patient selection prior to a transcatheter closure of an ASD can be avoided with this technique.     

Transcatheter closure of residual atrial septal defect following cardiac transplantation

An almost 3-year-old boy had a residual atrial septal defect after cardiac transplantation. The patient was symptomatic and had arrhythmia and cardiac enlargement. An atrial septal defect occlusion device was employed to close the communication with excellent results. Transcatheter occlusion enabled the patient to avoid further surgery and did not interfere with follow-up endomyocardial biopsies. © 1993 Wiley-Liss, Inc.     

Double atrial septal defect: diagnosis and closure guidance with 3D transesophageal echocardiography

Atrial septal defect (ASD) is a common form of congenital heart disease that often persists well into adulthood before discovery or intervention. The authors report the case of a patient referred for routine percutaneous ASD closure that was found on three-dimensional (3D) transesophageal echocardiography to have two large separate ostium secundum defects which were subsequently closed under 3D echocardiographic guidance.     

国产封堵器治疗房间隔缺损的应用

目的:评价应用国产封堵器治疗继发孔型房间隔缺损（ASD）的初步疗效。方法:31例ASD患者,ASD直径为1034（19±8）mm。所有患者在X线及经胸超声心动图（TTE）监视下经导管置入国产房间隔封堵器。治疗术后及术后3个月随访超声心动图、胸片、心电图,观察对血流动力学及心功能的影响。结果:全组手术成功率为100%,术后即刻及随访未见残余分流。与术前比较,三尖瓣口、肺动脉瓣口血流峰值明显降低,二尖瓣口血流峰值增加（P<0.05）,术后及随访期右心房、右心室内径缩小,右室射血分数早期下降,后期无明显变化。左室功能无明显变化,无出现新的心律失常和脑栓塞等并发症。结论:国产房间隔封堵器可有效治疗ASD,操作方便,手术成功率高,疗效可靠。有效改善右心高容量负荷状态。     

房间隔缺损并发畸形的介入治疗

目的 :评价同期应用介入治疗房间隔缺损 （ASD）及其并发心脏其它畸形的可行性和治疗效果。方法 :全组 7例 ,年龄 2～ 6 5 （34± 2 8）岁。经临床、心电图、X线及超声心动图诊断为 ASD并发其他心脏畸形 ,其中 3例为肺动脉瓣狭窄 ,2例为二尖瓣狭窄 （L utembacher综合征 ） ,2例为动脉导管未闭 （PDA ）。应用 Amplatzer封堵器经导管关闭ASD前 ,先纠正其它畸形 （包括瓣膜成形术及 PDA封堵术 ）。术后 3d,1～ 6月分别行经胸超声心动图 （TTE）、心电图、X线检查评价治疗效果。结果 :7例同期介入治疗均获得成功 ,术中未发生任何重要并发症。术后 3d,1～ 6月TTE显示房间隔无残余分流。并发肺动脉瓣狭窄患者 ,术后即刻跨肺动脉瓣压差得到满意的下降 ;L utembacher综合征患者 ,二尖瓣瓣口面积分别由术前 1.0 ,1.2 cm2增加到术后 1.9,2 .0 cm2 ,左房平均压分别由 2 9,2 6 m m Hg（1mm Hg=0 .133k Pa）降至 8,7m m Hg;并发 PDA患者 ,应用 Amplatzer封堵器 PDA关闭术后 10 min降主动脉侧位造影 ,无残余分流。术后 6月 X线检查显示肺血减少 ,心脏房、室缩小。结论 :同期介入治疗 ASD并发某些心脏畸形是一种有效、安全、简便可行的方法。     

超声心动图评价成人房间隔缺损封堵术后心脏结构和功能的变化

目的探讨超声心动图评价成人房间隔缺损(atrial septal defects,ASD)介入封堵术后心脏形态和功能变化。方法经超声心动图和心电图检查确诊为ASD并成功施行ASD封堵术的患者74例,年龄(35.63±12.74)岁,ASD直径为(16.29±5.11)mm。于封堵器堵闭术后24h、1个月、3个月、6个月和12个月进行经胸超声心动图追踪测量主动脉内径、左心室舒张末内径、左心室收缩末内径和右心室前后径,肺动脉内径和肺动脉瓣血流速度,右心房和右心室的上下径、主动脉瓣口血流速度、二尖瓣口血流速度、三尖瓣口血流速度和左心室射血分数,同时测量封堵器的直径和长度,并进行统计学分析。结果术后24h与术前相比,右心房内径、右心室内径、肺动脉内径、三尖瓣口血流速度和肺动脉瓣口血流速度均显著减少(P0.01);左心房内径、左心室内径、主动脉内径、二尖瓣口血流速度和主动脉瓣口血流速度均显著增加(P0.05);左心室射血分数无明显变化。房室大小和血流速度在术后24h内变化明显,在术后1个月后的随访中逐渐趋于稳定。结论封堵器介入封堵ASD,既纠正了解剖畸形,又改善了左心和右心系统的几何结构。     

经导管植入封堵器治疗儿童多发房间隔缺损疗效评价

目的探讨经导管植入封堵器治疗小儿多发房间隔缺损的可行性,并对其短期疗效进行初步评价。方法44例经胸超声心动图检查确诊多发房间隔缺损的患儿[男14例,女30例,年龄4(2～14)岁]于X线和经胸超声心动图监测下植入房间隔缺封堵器,术后复查经胸心脏超声心动图、心电图及X线胸片评估初步疗效,并通过随访分析评估短期疗效。结果44例患儿中,39例为2孔房间隔缺损,5例为3孔房间隔缺损。大缺损直径为(13.0±4.7)mm,小缺损直径为(5.4±2.3)mm;缺损之间间隔长(5.1±2.4)mm;所选择封堵器大小为(17.7±5.7)mm。44例均根据经胸超声心动图测量结果选择封堵器,5例植入2个封堵器,余39例植入一个封堵器,采用封堵器直径为(22±7)mm。封堵器植入均成功,在术中、术后及随访中所有患儿均无严重并发症。随访时间3个月～1年,所有患者的封堵器位置良好,心电图检查均未见心律失常发生。右心房舒张末期内径由术前的(29.2±5.8)mm降至术后6个月的(25.6±4.3)mm,差异有统计学意义(P<0.05);右心室舒张末期内径由术前的(28.2±5.7)mm降至术后6个月的(24.78±5.33)mm,差异有统计学意义(P<0.05)。术后即刻及24 h复查经胸超声心动图有6例(13.6%,6/44)少量残余分流和10例(22.7%,10/44)有中量残余分流,1例(2.3%,1/44)(5 mm)大量残余分流,成功率为75%(33/44)。6个月随访有3例(6.8%,3/44)患儿存在少量残余分流,6例(13.6%,6/44)存在中量残余分流,1例(2.3%,1/44)(4.1 mm)存在大量残余分流,封堵成功率为84.1%(37/44)。一年随访时有2例(6%,2/33)患儿存在少量残余分流,2例(6%,2/33)存在中量残余分流(n=33),封堵成功率94%(31/33)。结论经导管治疗多发房间隔缺损是安全的,疗效显著。在短期随访中右心室及右心房舒张末内径显著缩小。     

Look before you close: atrial septal defect with undiagnosed partial anomalous pulmonary venous return.

The growing and continued success of percutaneous closure of atrial defects is related to its high benefit-to-risk ratio in appropriately selected patients. The following case illustrates a previously undocumented danger, namely, the potential for incomplete correction. A thorough transesophageal examination performed at the time of the planned atrial defect closure suggested the presence of a partial anomalous pulmonary vein insertion, which was then appropriately documented and the incomplete closure was averted.     

应用Amplatzer封堵器治疗房间隔缺损

目的 :应用 Amplatzer封堵器治疗继发孔型房间隔缺损并对其疗效进行初步评价。方法 :全组共 6例 ,年龄38± 13岁 （2 0～ 5 5岁 ）。在透视及食管超声心动图监视下经导管置入 Am platzer封堵器封堵房间隔缺损。术后即时行食管超声心动图 ,术后 2 4h、1月、3月分别行经胸超声心动图评价治疗效果。结果 :全组疗效均佳 ,未见残余分流。结论 :应用 Am platzer封堵器治疗继发孔型房间隔缺损是有效的非手术方法 ,操作简便 ,成功率高 ,近期疗效可靠     

Transcatheter atrial septal defect closure with the Amplatzer septal occluder: five-year follow-up.

We report 5-year follow-up data of patients following atrial septal defect (ASD) closure with the Amplatzer septal occluder (ASO). Patients completed a questionnaire related to symptoms pre- and post-ASO implantation. Complete transthoracic echocardiography was used to assess residual atrial septal defect, right ventricular volume overload, and degree of mitral regurgitation. Mean follow-up duration was 4.8 +/- 0.6 years (range, 5.7-3.0 years). Complete closure was observed in all patients. Right ventricular volume overload, present in all patients prior to ASD closure, had resolved in 82% of patients. No mitral valve sequelae were found; 75% of patients were asymptomatic or felt much improved compared to their preclosure symptoms. New onset of migraine-type headaches was encountered in two patients, one for 12 months and one patient persisted with intermittent migrainous episode. In conclusion, we report 100% closure rate of ASD with ASO device, with return of right ventricular size to normal in the majority of patients. New onset of migraine headaches after ASO implantation can persist more than a few months.     

经胸超声心动图监视下应用Amplatzer封堵器治疗房间隔缺损

目的 :评价在经胸超声心动图 （TTE）指导下置入 Am platzer封堵器治疗继发孔型房间隔缺损 （ASD）的可行性和治疗效果。方法 :全组 5 0例 ,年龄 1～ 5 1（18.8土 14.6 ）岁 ,术前经 TTE检查示 ASD直径平均为 4～ 33（18.3土 6 .0 ） mm。所有病例均在透视及 TTE监视下经导管置入 Amplatzer封堵器封堵 ASD。术后 3d,1～ 3月分别行经胸超声心动图、心电图及 X线检查评价治疗效果。结果 :5 0例 ASD直径的球囊测量值为 5～ 35 （19.1土 6 .9）mm,选择的封堵器直径为 5～ 36 （2 0 .9土 7.0 ） m m。 5 0例封堵器置入均获得成功 ,技术成功率为 10 0 % ,术中未发生任何重要并发症 ,无急诊手术病例。术后即刻 TTE显示 4例 （8.0 % ）存在微量至少量残余分流。术后 3天 TTE显示 2例 （4.0 % ）存在微量残余分流。术后 1～ 3月 TTE显示 5 0例 ASD完全闭合。X线检查全部显示肺血减少、右心房、室缩小。结论 :经胸超声心动图指导下经导管置入 Am platzer封堵器治疗 ASD是一种有效、安全、可行的非外科手术方法。我们建议 30 m m以上的 ASD应在经食道超声心动图下监视封堵。     

实时三维超声心动图对经导管闭合房间隔缺损术后的观察

目的 :探讨实时三维超声心动图 （RT- 3DE）对经导管闭合房间隔缺损 （ASD）术后观察的价值。方法 :对 15例ASD患者术后封堵器的位置、形态、塑型、大小及运动进行 RT- 3DE观察 ,并与手术结果进行比较。结果 :RT- 3DE显示封堵器呈双盘状 ,测得封堵器伞腰直径为 2 7± 5 mm ,与实际封堵器大小 （2 6± 5 mm ）比较无显著差异 （P>0 .0 5 ） ;封堵器相对房间隔无移位 ,随心脏运动 12例无扩展和收缩 ,形状也无变化 ,3例有变化。结论 :RT- 3DE成像速度快 ,模拟外科手术路径实时显示封堵器的位置、形态和塑形以及和周围组织的关系 ,可作为 ASD介入治疗术后疗效评价的重要手段。     

Transcatheter patch closure of an atrial septal defect of sinus venosus type using the immediate release patch

Following promising preclinical studies, we report our first clinical experience with transcatheter closure of an atrial septal defect of sinus venosus type in a 65‐year‐old patient using the Immediate Release Patch. © 2015 Wiley Periodicals, Inc.     

Helex device closure of multiple atrial septal defects

Objectives : To describe the effectiveness of the Helex Septal Occluder (HSO) to close multiple atrial septal defects (mASDs). Background : Limited information is available describing closure of mASDs with the HSO. Methods : A total of 28 patients who underwent closure of mASDs with the HSO were identified by retrospective review of our catheterization database between 2001 and 2012. Procedural details and follow up information were collected. Results : Median age was 19.2 years, median weight 48 kg, with 10 (36%) patients weighing <25 kg. Indication for closure was RV enlargement (RVE) in all patients and additionally neurologic events occurred in 3/28 (11%). Median stop‐flow diameter for the largest ASD was 14 (4–23) mm. One HSO was implanted in 21/28 (75%), 2 in 6/28 (21%), and 3 in 1/28 (4%). One embolization and one transient arrhythmia occurred with no sequelae. Immediate residual shunt was absent in 5/28 (18%), trivial in 15/28 (54%), small in 6/28 (21%), and moderate in 2/28 (7%). Of the 25 patients with ≥6 months follow‐up (median 53 months), residual shunt was absent in 13/25 (52%), trivial in 5/25 (20%), and small in 7/25 (28%). RVE resolved in all but one patient with no other associated lesions and ≥6 months of follow‐up. No patient with prior neurological event had recurrence at last follow‐up. Conclusions : We conclude that closure of mASDs with ≥1 HSO is effective with a low complication rate. The ability of HSO devices to overlap or sandwich each other may facilitate safe implantation of multiple devices in smaller patients. © 2013 Wiley Periodicals, Inc.     

40岁以上继发孔型房间隔缺损介入治疗的评价

目的 :评价 40岁以上继发孔型房间隔缺损 （ ASD）介入治疗的效果。方法 :全组 45例 ,年龄 40～ 65 （ 4 9土 7）岁。术前超声心动图检查 ASD最大直径 8～ 3 8（ 2 7土 7） mm。并发高血压 13例 ,糖尿病 2例 ,三尖瓣关闭不全 2 9例 ,二尖瓣关闭不全 8例 ,心房纤颤 4例 ,频发房性早搏 9例。所有病例均经导管置入 Amplatzer ASD封堵器。 1例大小紧邻的两个 ASD,采用一个封堵器关闭两个缺损。 1例两个 ASD相距较远 ,用两个封堵器分别关闭。术后 48h,1～ 3月分别行经胸超声心动图 （ TTE）、心电图及 X线检查。结果 :44例选择的封堵器直径为 10～ 40 （ 3 1土 7）m m。 1例双孔 ASD（分别 8m m和 16mm） ,分别采用 12 mm和 2 0 mm两个封堵器。封堵器置入均获得成功 ,技术成功率为 10 0 % ,术中未发生任何重要并发症 ,无急诊手术病例。术后即刻 ,TTE显示 3例 （ 7% ）存在微量至少量残余分流 ;术后 48h TTE显示 2例 （ 4 .4% ）存在微量至少量残余分流 ;术后 3月无 1例残余分流。术后右心房、室缩小 ,心功能明显改善。结论 :Amplatzer封堵器适合于 40岁以上继发孔型 ASD的介入治疗 ,具有操作简便、安全、技术成功率高及封堵效果好等优点     

特殊类型房间隔缺损的介入治疗及远期随访观察

目的:探讨特殊类型房间隔缺损(ASD)介入治疗的适应证及注意事项,观察其术后远期疗效及安全性。方法:我院1999-12-2009-01期间经胸和(或)经食管超声心动图(TTE、TEE)行术前筛选并成功随访的特殊类型ASD患者116例,评估后应用房间隔封堵器(ASO)介入封堵,于术后远期随访观察并发症的发生,同时追踪心脏超声及心电图变化。结果:所有患者术后随访40～120(90±46)个月。111例封堵成功,技术成功率95.7%;随访中发生严重并发症4例(3.6%),其中1例封堵器脱落,1例溶血,1例脑栓塞及1例明显主动脉瓣反流;手术成功率为94.8%(110/116);9例(8.2%)术后即刻有残余分流,随访中5例分流消失,完全封闭率96.4%;ASD患者术后心脏重构较术前显著改善,尤以年龄<18岁者改善明显;术前心电图2例存在室上性心动过速,随访中未见再发作;5例心房颤动,随访中2例恢复窦性心律,未见室性心律失常,24例原有右束支传导阻滞,术后6例消失。结论:术前了解ASD解剖细节,严格掌握适应证是ASO治疗特殊类型ASD手术成功的关键,远期随访疗效肯定。